POS1474-HPR FATIGUE IS AN IMPORTANT COMORBIDITY FOR RA PATIENTS. HOW CAN WE MEASURE IT EASILY IN CLINICAL PRACTICE?
Authors: B. Frade-Sosa, R. Morlà, N. Sapena, R. Sanmartí, J. A. Gómez-Puerta
Journal: Annals of the Rheumatic Diseases (2022)

Background Fatigue is highly prevalent (40-70%) in Rheumatoid Arthritis (RA) 1 . Patients describe fatigue as an important symptom, in discrepancy with rheumatologist´s perception. Different validated questionnaires are available to measure fatigue, without any standarised preference in their use. In randomized controlled trials, FACIT-F is a unidimensional tool for fatigue widely used. MDHAQ is a multidimensional tool exploring different dimensions of RA, providing a VAS 0-10 for fatigue as a simple scale to measure it 2 . Objectives We studied fatigue in RA patients with two different questionnaires, FACIT-F and VAS 0-10 included in MDHAQ, and evaluated their utility in clinical practice. Methods Patients with RA (ACR/EULAR criteria, 2010) who agreed to participate in this study were included consecutively in the Arthritis Unit for 3 months. They fulfilled 2 questionnaires to evaluate fatigue: 1. FACIT-F(FS)=FACIT-Fatigue, 13 questions (0-4 score) with a global score of 0-52 (lower scores indicate worse fatigue). 2. VAS 0-10 of fatigue (=VAS-Fatigue) included in the question 9 in MDHAQ. Other self-reported queries of the MDHAQ were collected: 1-10 physical function (FN) according to modified HAQ (0-10), VAS 1-10 for pain (PN) and patient global assessment (PATGL) to calculate RAPID3, a review of 60 symptoms (ROS60) and self-assessment 48 joint count (RADAI48). Physical articular examination (TJC 0-28, SJC 0-28), laboratory test (CRP, ESR), composite EULAR disease activity indices (DAS28-ESR, SDAI), demographic (sex, age, BMI) and patient´s disease characteristics, also screened for depression with Patient Health Questionnaire 9= PHQ9≥10) were collected. A descriptive analysis of the variables was done, and Pearson´s correlation between FACIT-Fatigue and VAS-Fatigue scores, and between each questionnaire (FACIT-Fatigue and VAS-Fatigue) and the rest of variables was performed. Results A total of 75 patients (84% females) with RA were recruited, with a mean age of 62 (±11.6) years, a mean disease duration of 14.6 (± 5) years, a mean BMI of 22.8 (± 8.0), 64% with bDMARD and 45.3% with glucocorticoids treatment. Depression (PHQ9≥10) was observed in 16%. Correlation between the two studied questionnaires (FACIT-Fatigue and VAS-Fatigue) was almost very good (-0.79, p&lt;0.001). Statistically significant (p&lt;0.05) similar correlation ~0.70 were obtained between VAS-Fatigue (range: 0.60, 0.76) and ~0.80 between FACIT-Fatigue (range:-0.70,-0.87) and self-reported MDHAQ queries (FN, PN, PATGL, RAPID3, ROS60, and RADAI48). Similar but moderate correlation~0.50 (range:0.42,-0.61) was obtained in both questionnaires with TJC and EULAR indices of disease activity (DAS28-ESR, SDAI), and similar but lower ~0.20 (range:0.24, -0.29) with inflammatory variables (CRP, ESR, SJC) except for ESR and FACIT-Fatigue, no correlation was observed. Depression (PHQ9≥10) obtained the highest correlation with -0.92, p&lt;0.001 in FACIT-Fatigue, and less for VAS-Fatigue 0.66, p&lt;0.001 (Table 1). Table 1. Correlation between VAS-Fatigue and FACIT-Fatigue and the different disease activity variables. VAS-Fatigue (0-10 ) p-value FACIT- Fatigue (0-52 ) p-value FACIT-Fatigue (0-52 ) -0.79 &lt;0.001 1 VAS-Fatigue (0-10 ) 1 -0.79 TJC (0-28 ) 0.42 &lt;0.001 -0.58 &lt;0.001 SJC (0-28 ) 0.24 0.040 -0.29 0.014 CRP 0.27 0.021 -0.28 0.017 ESR 0.25 0.032 -0.20 0.096 DAS28-ESR 0.52 &lt;0.001 -0.61 &lt;0.001 SDAI (0-86 ) 0.49 &lt;0.001 -0.58 &lt;0.001 FN (0-10 ) 0.76 &lt;0.001 -0.87 &lt;0.001 PN (0-10 ) 0.70 &lt;0.001 -0.62 &lt;0.001 PATGL (0-10 ) 0.75 &lt;0.001 -0.73 &lt;0.001 RAPID3 (0-30 ) 0.77 &lt;0.001 -0.75 &lt;0.001 ROS60 (0-60 ) 0.66 &lt;0.001 -0.77 &lt;0.001 RADAI48 (0-48 ) 0.60 &lt;0.001 -0.70 &lt;0.001 PHQ9 (0-27 ) 0.66 &lt;0.001 -0.92 &lt;0.001 Conclusion VAS (1-10) is a good tool compared to FACIT to easily measure of fatigue in daily routine for RA patients. The use of this simple scale integrated in the MDHAQ allows capturing important clinical information for the disease. References [ 1]Hewlett S, et al. Rheumatology 2011;50:1004-6. 2. Hewlett S, et al . Arthritis Care Res 2011; 63: S263-86. Disclosure of Interests Beatriz Frade-Sosa: None declared, Rosa Morlà: None declared, Nuria Sapena: None declared, Raimón Sanmartí Speakers bureau: Abbvie, BMS, Gebro-Pharma, Lilly, MSD, Pfizer, Sanofi, Roche, José A Gómez-Puerta Speakers bureau: Abbvie, BMS, Galápagos, GSK, Janssen, MSD, Lilly, Pfizer, Roche, Consultant of: Galapagos, Roche, Sanofi